Controversies on pharmacokinetics of fluoroquinolones in elderly patients

Antibiotic treatment of elderly patients poses several problems including uncertainty about the dosage of fluoroquinolones. Huge interindividual differences characterise the pharmacokinetics of fluoroquinolones, and these differences may surpass several times the age-related average alterations. No routine dose adjustment can be recommended, since the outcome of treatment might be jeopardized by an unwarranted dose reduction. At present, creatinine clearance is the best guide for dose adjustment, but in the case of severe infection, even monitoring of serum concentration might be necessary. Individual dosage is required for elderly patients, taking into consideration the severity and site of infection, the general condition of the patient and the sensitivity of the pathogen.